title: Radical reduction of cephalosporin use at a tertiary hospital after educational antibiotic intervention during an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae.
abstract: OBJECTIVE
  During an outbreak of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae at our hospital, we performed an educational antibiotic intervention aimed at reducing prescriptions of second- and third-generation cephalosporins and preventing increased use of fluoroquinolones and carbapenems. In this report, we describe the implementation strategy used and evaluate the intervention effect according to Cochrane recommendations.
  
  
  METHODS
  New recommendations for empirical intravenous antibiotic treatment were communicated to prescribers throughout the hospital by infectious diseases physicians working with Strama (the Swedish strategic programme against antibiotic resistance). No restrictive measures were used. The intervention effect was analysed with interrupted time series (ITS) regression analysis of local and national monthly antibiotic sales data.
  
  
  RESULTS
  A radical immediate and sustained reduction was demonstrated for the cephalosporins targeted in the intervention, whereas consumption of piperacillin/tazobactam and penicillin G increased substantially. Fluoroquinolone and carbapenem use was essentially unchanged. The ESBL outbreak subsided and no increased resistance to piperacillin/tazobactam was detected in K. pneumoniae, Escherichia coli or Pseudomonas aeruginosa blood isolates during the 2.5 year follow-up.
  
  
  CONCLUSIONS
  Our study clearly demonstrates that an educational intervention can have an immediate and profound effect on antibiotic prescription patterns at a large tertiary hospital. ITS regression analysis of local and national antibiotic sales data was valuable to readily assess the immediate and sustained effects of the intervention.
authors.affiliation: Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. thomas.tangden@gmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Tängdén
authors.forename: Britt-Marie
authors.initials: BM
authors.lastname: Eriksson
authors.forename: Asa
authors.initials: A
authors.lastname: Melhus
authors.forename: Bodil
authors.initials: B
authors.lastname: Svennblad
authors.forename: Otto
authors.initials: O
authors.lastname: Cars
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002511:Cephalosporins / Q000008:administration & dosage*; D004196:Disease Outbreaks; D004363:Drug Utilization / Q000592:standards*; D004493:Education / Q000379:methods; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000302:isolation & purification; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D001618:beta-Lactamases